HIV infection patterns have shifted toward rural minorities, but little is known about relevant risk factors and behavior patterns, including substance use, which is essential for developing population sensitive and specific interventions. Sound measurement of risk behaviors is fundamental to this initiative, and this 2-year R21 application proposes to adapt and evaluate the utility of an innovative telephone-based Interactive Voice Response (IVR) self-monitoring system for use with poor rural HIV+ substance users. The proposed measurement development study is guided by behavioral economics, which is concerned with patterns of choice over different timeframes. The study is an important first step that will support research on risk factors and patterns among rural HIV+ substance users and their social networks and will guide the development of interventions aimed at risk reduction, including telehealth services. Telehealth services have much potential to extend the reach and effectiveness of health-related interventions in rural areas. Following a pilot study to finalize procedures, participants (N = 50) will be recruited from HIV+ patients at a rural Alabama HIV medical clinic who report drug or alcohol use and sexual activity involving a partner during the past 90 days. After assessment and training, participants will self-monitor their substance use, sexual practices, and social and economic variables relevant to HIV-risk exposure opportunities for 10 weeks using the IVR system. Structured reliability interviews will be conducted at the end of Weeks 5 and 10 to assess data quality through comparisons with key IVR variables reported during the same real time periods. Data quality also will be assessed for select variables amenable to comparisons with medical records (e.g., medical care visits) and with summary measures of substance use and sexual practices prior to the start of self-monitoring. Successful adapation of the IVR system will allow collection of prospective time series data that support detailed analysis of risk patterns, including longitudinal sequences involving substance use, risky sexual practices, and social and economic contextual variables. In addition to providing a high quality measurement tool for behavioral research, the IVR system can be used for long-term remote ambulatory monitoring of patient status and can support precisely targeted risk reduction interventions that can be individually tailored. [unreadable] [unreadable] [unreadable] [unreadable]